Provider Demographics
NPI:1114649498
Name:STIFTER, SKYLA (DPT)
Entity Type:Individual
Prefix:
First Name:SKYLA
Middle Name:
Last Name:STIFTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 STRAUSS CABIN RD APT #10-105
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-4672
Mailing Address - Country:US
Mailing Address - Phone:360-216-5914
Mailing Address - Fax:
Practice Address - Street 1:375 E HORSETOOTH RD BLDG 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-286-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist